Background: Vesicoureteric reflux (VUR) is an important association of pediatric urinary tract infection (UTI) found in 30 50% of all children presenting with first UTI. Contrast-enhanced voiding ultrasonography (ceVUS) has become an important radiationfree method for VUR detection in children. Its sensitivity in detecting VUR has greatly improved due to the development of the contrast-specific ultrasound techniques and the introduction of the second-generation ultrasound contrast agent, superseding the diagnostic accuracy of standard radiological procedures.
Aim: To discuss the first local pilot study performed in our institution on detection of vesicoureteric reflux by contrast-enhanced voiding ultrasonography with second- generation agent (SonoVue, Bracco, Italy).
Material & Methods: A total of 118 children with 236 nephroureteral units (NUUs) were evaluated using ceVUS. Age range 2 months to 18 years (mean: 6.4±4.9). Indications for ceVUS were acute pyelonephritis and recurrent urinary tract infection (62 children), hydronephrosis/small kidney (20 children) and control investigation for VUR during conservative management or after endoscopic correction (36 children). The majority of examinations were well tolerated without any adverse incident. One 3 months old girl where massive V grade VUR was detected, developed acute pyelonephritis as complication of the catheterization. Three children had painful micturation in the following few days, but no infection.
Results: VUR was shown in 62 (52.5%) children in 97/236 (41%) NUUs. It was unilateral in 47 and bilateral in 25 children. In 52 NUUs VUR was grade II/V in 26 Grade III/V, in 16 grade IV/V and in 3 grade V respectively. Urethra was shown in 90/118 children and in all boys, without major pathological finding. In 9 girls spinning top urethra has been shown. Subsequent urodynamic studies performed in 5 of them, revealed functional bladder problem.
Conclusions: Contrast-enhanced voiding urosonography using intravesical second generation ultrasound contrast agent could be recommended as a valid alternative diagnostic modality for detecting vesicoureteral reflux and evaluation of the distal urinary tract in children, based on its radiation-free, highly efficacious, reliable, and safe characteristics.